title: Hyperglycemic hyperosmolar syndrome caused by steroid therapy in a patient with lupus nephritis.
abstract: A 51-yr-old female was referred to our outpatient clinic for the evaluation of generalized edema. She had been diagnosed with idiopathic thrombocytopenic purpura (ITP). She had taken no medicine. Except for the ITP, she had no history of systemic disease. She was diagnosed with systemic lupus erythematosus. Immunosuppressions consisting of high-dose steroid were started. When preparing the patient for discharge, a generalized myoclonic seizure occurred at the 47th day of admission. At that time, the laboratory and neurology studies showed hyperglycemic hyperosmolar syndrome. Brain MRI and EEG showed brain atrophy without other lesion. The seizure stopped after the blood sugar and serum osmolarity declined below the upper normal limit. The patient became asymptomatic and she was discharged 10 weeks after admission under maintenance therapy with prednisolone, insulin glargine and nateglinide. The patient remained asymptomatic under maintenance therapy with deflazacort and without insulin or medication for blood sugar control.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 641 Banpo-ro, Seoul, Korea.
authors.forename: Seok-Hui
authors.initials: SH
authors.lastname: Kang
authors.forename: Ja-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Hoon-Suk
authors.initials: HS
authors.lastname: Park
authors.forename: In-O
authors.initials: IO
authors.lastname: Sun
authors.forename: Sun-Ryoung
authors.initials: SR
authors.lastname: Choi
authors.forename: Byung-Ha
authors.initials: BH
authors.lastname: Chung
authors.forename: Bum-Soon
authors.initials: BS
authors.lastname: Choi
authors.forename: Chul-Woo
authors.initials: CW
authors.lastname: Yang
authors.forename: Yong-Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Cheol-Whee
authors.initials: CW
authors.lastname: Park
mesh_terms: D004487:Edema; D004831:Epilepsies, Myoclonic / Q000150:complications / Q000188:drug therapy; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced*; D007165:Immunosuppression Therapy; D007328:Insulin / Q000627:therapeutic use; D008181:Lupus Nephritis / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications / Q000188:drug therapy*
chemical_list: D007328:Insulin; D011239:Prednisolone